Recognizing and managing deception in the therapeutic relationship

I had been working with “Alex,” an 8-year-old boy diagnosed with attention-deficit/hyperactivity disorder, for longer than six months. His hyperactivity had become a major problem at school, and much of our clinical focus had been on managing behavior in the school environment. Each week, Mrs. T, his mother, who drove almost three hours to bring Alex to see me, confirmed that his behavior was improving. Then, one cold December afternoon, she appeared for our appointment without Alex.

“I’m sorry,” she said, “but I haven’t been honest with you. Alex’s behaviors haven’t improved at home or at school. I’ve lied about it all along, and I don’t know why. We are withdrawing from therapy, but I wanted to tell you to your face.”

Mrs. T was embarrassed. She apologized profusely, thanked me and then left. I never saw her or Alex again.

I was devastated. I had been in the field for more than 20 years and had never had anyone be so overtly dishonest with me. Mrs. T had paid me a lot of money and invested a substantial amount of time driving Alex to and from therapy. I couldn’t understand why she hadn’t simply told me the truth all along.

From this experience, I learned the valuable lesson that I can’t always take a client at his or her word. But how can we know when clients are not being truthful? What clients are most likely to deceive? How can we identify and manage deception? The answers aren’t simple ones.

Problems with research

Before I address the questions at hand, some caveats about the research on deception are necessary. The research on indicators of lying is so full of conflicting ideas that little sense can be made of it all. Even some of the best studies have serious problems.

For example, some studies have argued that agents from the former U.S. Customs Service are no better at detecting lies than the average person. But many of these laboratory studies have subjects lie about little things such as “I have the ace of spades in my pocket” when in fact they don’t. These are called “low-stakes lies.” Nobody goes to jail for lying about having a playing card in his or her pocket. But when it comes to high-stakes lies — lies that are meaningful — Customs agents are much better at detecting lies than most of us.

In fact, it is easy for people to lie about little things. Most of us do it regularly in daily life.

“Do you like my sweater?”

“Um, yeah …”

These little white lies are meaningless in the big picture of life. But the physiological response to lying about big things (“No, sir, there are no illegal drugs in my bag”) is much harder to suppress. These are lies that most of us don’t tell.

Among the beliefs that have been held in the past are that liars fidget more, don’t make eye contact and stutter more frequently. Although sometimes these things are true, sometimes they aren’t. These oversimplifications were based on problematic research methodology. Today we know much more about deception. But before we look at what people who tell lies do, let’s look at who lies and why they tell the lies they tell.

Who lies?

All of us lie. We just lie about different things. Unless we are pathological liars, we regularly evaluate the cost or benefit of telling the truth, which often involves determining the likelihood of delaying or avoiding a certain cost or increasing a particular benefit by using deception.

For example, if someone made a meal for you and asked if you liked it, you might lie to protect the person’s feelings if you didn’t really enjoy it. The cost of the truth — hurt feelings — is much higher than the cost of a little white lie. The cost of a child telling me (a counselor) the truth about his or her abuse is shame, embarrassment and humiliation. The lie often feels much safer to the child.

For that reason, over several decades of experience working with children who have been sexually and physically abused, I have found that almost all children attempt to deceive me at some level in the initial interview. My question of whether anyone has ever touched them in a way that hurt them or made them feel uncomfortable is nearly always met with a “no” response, even when I already know that the child has been sexually or physically abused. They don’t trust me enough to tell me that secret yet.

By recognizing those clients who might be motivated to lie because of what the truth might cost them, we can, as counselors, better predict the likelihood that a lie is being told.

Why it matters

Nearly all of our clients will lie to us at some point. Lying can take several forms. A person can lie by saying something that isn’t true (called falsification) or by denying something that is true (called concealment).

Lies can be blatant. Former President Bill Clinton displayed this form of deception when he told the media, “I did not have a relationship with that woman.” But many lies are not so blatant. Clients might deflect as a form of lying. Again, in the case of the former president, he drew a lot of attention for his statement, “It depends on what the meaning of the word is is.” This is a common method a person who is lying might attempt to use to save his or her reputation (cost) by parsing terms. The person rationalizes that his or her response wasn’t really a lie by deflecting and answering a different question.

Clients might also lie by diminishing their behavior: “Well, I didn’t really hit my husband. I lost my balance and my hand might have touched his face.”

All these forms of lying might be seen in nearly any counseling context — marriage counseling, alcohol and drug counseling, anger management, working with court-ordered clients and so on. The accuracy of the information we get from our clients matters to us as therapists because we structure our interventions and treatment plans and measure progress based on what our clients tell us. When they deceive us, as Mrs. T did to me, at the very least we waste therapeutic resources. But we might also miss important pieces of information that are critical to a client’s survival. For example, a client who is attempting to manage suicidal ideation might end up succeeding at suicide if we miss the intensity and frequency of the individual’s ideation due to deception.

All of us can expect our clients to deceive us at some point. I was taught early in my education that “the problem is never the problem.” My professors and clinical supervisors were trying to demonstrate the importance of rapport and trust in a therapeutic relationship. Part of that is expecting that, sometimes, the stated presenting problem isn’t really why the client came in. Clients have to learn that they can trust us before they will tell us what they really want to talk about.

Therefore, early on in the relationship, I am always listening for hints that there might be more to the story than I am being told. I have found that, oftentimes, my teachers were correct.

High-risk populations

Several client populations are at particularly high risk for lying, including incarcerated individuals, children in foster care, clients who are addicted, people involved in sexual assaults and clients who are suicidal.

Prisoners and juvenile detention: Kenneth Bianchi, also known in the 1970s as the Hillside Strangler, came very close to successfully duping several of the country’s most renowned experts on multiple personality disorder (as it was known then) by faking the disorder while supposedly under hypnosis.

These professionals made a critical mistake. They naïvely believed that Bianchi wouldn’t — and, more importantly, couldn’t — fool them. These experts had extensive experience working with clients who were motivated to tell the truth, but a person accused of serial crime is highly motivated to lie.

Any client or patient familiar with the “system” is at risk for manipulating it. One of the lead psychologists in the Bianchi case later served as a clinical director in a prison. He acknowledged that the experience of working with prisoners confirmed that he had been naïve in the Bianchi case.

Most therapists have the luxury of believing their clients will tell the truth, or at least near truths, much of the time. But when working with those who are incarcerated — either those in the juvenile justice system or adults in the prison system — one must verify all information by a second source because the motivation to lie is so high. We have done this with alcohol and drug treatment patients for years.

“I didn’t smoke anything this week.”

“OK, I believe you. Please pee in the cup.”

“But I haven’t smoked anything …”

“Fine. Please pee in the cup.”

Clients who are addicted could be telling the truth, but the information must be verified. Manipulating people for one’s own gain is inherent in the prison system, where inmates have very little power and must always look out for themselves. Nobody trusts anybody. Inside the prison block or juvenile hall, deception is an everyday part of life, giving people motive to lie and providing ample opportunity to practice. In other words, telling the truth doesn’t outweigh the benefits of the lie — more privileges, freedom or exoneration.

Accusations of sexual abuse: Generally, young children do not falsely accuse others of sexual or physical abuse. They have too much to lose. As noted earlier, the opposite is far more likely. I’ve seen hundreds of children who have been physically or sexually abused by caregivers, and most of these children still want to go home. They want the abuse to stop, but they don’t want to be elsewhere, even if it means returning to the homes of their abusers. Therefore, they are not motivated to make up abuse allegations but rather motivated to lie that it did not occur (concealment).

The exception to this general rule involves teenagers who know how to manipulate their parents or guardians with threats of intervention by child protective services and children who have been exposed to the “system” (see the preceding section on prisoners and juvenile detention.) Sadly, I’ve seen several cases in which adolescent children in foster care accused a foster parent of sexual misconduct or abuse simply to exact revenge on the foster parent for a perceived grievance. These teens knew how to work the system.

Sometimes, parents also have a motivation to lie about abuse. I have worked with dozens of parents who were divorcing. In some of these cases, one of the spouses has either accused the estranged spouse of abuse or proposed a “concern” about potential abuse simply to improve his or her own position in the custody hearing. People know that the mere accusation of abuse can have an effect on a judge’s decision for custody. In these cases, the benefit of the lie may outweigh the benefit of the truth.

Rape allegations: Unfortunately, I have been in the position several times of having to evaluate the truthfulness of a victim and her alleged rapist. This is a very sensitive process because a mistake in either direction has tragic consequences. If I wrongly suppose an accused rapist is telling the truth, I have provided data that might let him avoid charges. Even more serious, I have contributed to one of a victim’s greatest fears — that she won’t be believed. On the other hand, if I errantly believe an accuser, an innocent man may go to prison and be labeled a sexual offender for the rest of his life.

Generally, the accuser is least motivated to lie, but both parties can possess motives to lie. The accused, obviously, is motivated to lie to avoid prosecution. But in false allegations of rape, the accuser is motivated also. In two of my cases, it was discovered that the accusers had engaged in consensual sex and then, fearing pregnancy or disease, realized their indiscretion would eventually come to light. A false accusation of rape provided the accusers with the benefit of being “victims” rather than facing the cost to their reputations of promiscuous sexual liaisons. Please note, however, that the data is quite clear. Most victims of rape never even call the police. Therefore, the accused is far more likely than the accuser to lie.

Suicide risk: Perhaps the most common instance in which clinicians will encounter deception is with suicidal risk assessment. Early in my career, I was working with a 19-year-old woman who was exhibiting suicidal tendencies. We had been working together for several weeks, and our rapport was strong. In one session, she verbally consented to a safety contract, agreeing to contact me before the next session if she felt suicidal. She left my office, and within two hours, I received a call from her mother saying that my client had taken an overdose of medication.

Fortunately, she survived, but there was no doubt that I had missed something and that my client had lied to me. It was my responsibility to take into account all risk factors, and I had failed. Part of my suicide risk assessment now involves evaluating what stressors a client might have after leaving my office, even if I believe the client is telling me the truth. Clients have to convince me that they are not simply saying what they think I want to hear.

Detecting lies

So, how can we detect lying? This is a process with many variables, but here are some of the basics.

1) The first issue is for the counselor to ask himself or herself if the client has a motive to lie. Is the cost of the truth potentially higher than the cost of the lie? If so, be on guard. How much trust has been built in the therapeutic relationship? When little trust has been established (such as early in the relationship), this increases the cost of the truth to our clients.

2) When telling a lie, people often provide unnecessary detail, and their stories are often presented verbatim over several tellings. When someone is simply describing an event, the gist of the event is what matters, and sometimes small details vary because they are comparably unimportant. Someone who is lying, however, feels the need to “prove” that his or her story is genuine by providing minute, memorized detail that doesn’t change much from one telling to another.

3) The story of a person who is lying won’t match the known facts. In a complicated story, cross-referencing facts can often lead to an untruthful person’s downfall because there are simply too many details to keep in working memory while the lie is being constructed. Lying requires an immense amount of mental energy.

4) People who are lying may not look you in the eye, but they may be just as likely to stare if they are trying to concentrate on being believable. Staring is an example of a “countermeasure.” As described in a 2014 article for FBI Law Enforcement Bulletin by Brian D. Fitch, these are behaviors construed in an attempt to prevent the hearer from recognizing the lie. The person may believe that “people who lie don’t look you in the eye,” so he or she attempts to counterbalance that by staring. When telling the truth, a client is more natural in either situation, looking off into space at times and making occasional eye contact in the same way.

5) When people lie, they often ramble on and on. When I’m interrogating a suspect in a legal situation, I sit quietly and let the person talk. The person telling the truth will tell the story and then wait for instructions or a response from me. Uncomfortable with silence, the person telling a lie will continue to talk, adding flowery language and detail to the story.

6) People who are telling lies are more physically stiff, use fewer hand motions, are more negative and use fewer first-person pronouns, according to a 1997 article by Mark Frank and Paul Ekman in the Journal of Personality and Social Psychology.

7) People who are telling lies often exhibit microexpressions. As described in a 2011 FBI Law Enforcement Bulletin article by David Matsumoto, Hyi Sung Hwang, Lisa Skinner and Mark Frank, these are behaviors that communicate a feeling such as contempt or disgust. Microexpressions that communicate an emotion inconsistent with the words being spoken are important clues. For example, a client who should be feeling relief at the telling of a story but is instead exhibiting contempt should be considered potentially untruthful.

Four steps to managing deception

The first step in managing deception with clients is recognizing that deception has occurred. The second step is determining what form the deception has taken (blatant, deflecting, diminishing, falsification or concealment).

Third, the counselor must decide if the deception must be confronted. Early in a therapeutic relationship, I sometimes can tell that I’m not getting the whole story, but my client needs to trust me more deeply before confiding certain secrets. In these cases, I don’t confront the deception. Once trust has been established, however, or in cases in which I am confident that confrontation is the proper therapeutic tool, I address the deception head-on.

Finally, the counselor must evaluate the therapeutic relationship and decide why the client didn’t trust the counselor with the truth. In the case of Mrs. T, I suspect that her deception was more for her than for me. She wanted so desperately for her son to be “normal” that it was more costly to admit that he wasn’t normal than to admit that nothing was working. She trusted me but couldn’t face the fact of her disappointment in her son.

Conclusion

At some point, we have to trust our clients. Mrs. T betrayed my trust in her, and this came at the expense of her son. But looking back, she gave me hints that she wasn’t being honest.

Therapy went too easily. She confirmed that things were better each week almost before I asked. Her confirmation that things were going well were inconsistent with some of the behaviors I saw in therapy and in the child’s sand trays — so much so that at one point, I consulted with a colleague on these inconsistencies.

But Mrs. T provided multiple energetic and animated stories to prove to me that therapy was working. She was anxious and nervous when I asked about her son’s progress at school and often jumped ahead in the conversation at a pause or lull in our discussions. In hindsight, the most notable clue was that she looked me straight in the eye, almost staring at me, each week as she lied to me.

I still don’t know why Mrs. T was motivated to lie to me, but perhaps the most important lesson I learned from her is that clients will, indeed, deceive me if I’m not careful. In her case, I never even bothered to consider the possibility of deception. It was a mistake I haven’t made again.

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Gregory K. Moffatt, a licensed professional counselor, runs a private practice in which he specializes in working with children who have experienced physical or sexual abuse. He is also a professor of counseling and human services at Point University in Georgia and serves as a risk assessment and psychological consultant for businesses, schools and law enforcement agencies. Contact him at Greg.Moffatt@point.edu.

Thank you. I am only a client, but your article helps. Is the practice of confronting a client with accusation of dishonesty in the first meeting now in vogue? I have had two therapists and one MD do this the first time we met. I never went back, and now I am too scared to get medical help for anything but serious physical distress that the doc can see for himself. I look forward to reading more of your soothing and helpful writing.

How is self deceits beneficial and bad at the same time? What more could you do to help yourself once you’ve already disagreed? In any Given case. How do people get away with lies when honestly lurches beneath every cause.

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